Omentalisation as adjunctive treatment of an infected femoral nonunion fracture: a case report

A three-year-old male working border collie with an infected femoral nonunion fracture was managed in a two-stage procedure involving debridement and omentalisation, followed by stabilisation with a bone plate and an autogenous cancellous bone graft. Osseous union was documented radiographically 16 weeks after surgery. Telephone follow-up one year later revealed the dog had returned to full working function without evidence of lameness. To the authors' knowledge, this is the first clinical case described in the veterinary literature using omentalisation as an adjunct to the management of an infected, biologically inactive nonunion fracture.     

Pulmonary artery compression in a Thoroughbred colt due to a mediastinal abscess

In the case presented, a young horse was referred for further evaluation based on a presumptive diagnosis of pulmonic valve endocarditis, bronchopneumonia and a cranial mediastinal abscess based on thoracic ultrasound, echocardiography and clinical signs. However, further echocardiographic evaluation revealed that the abscess was compressing the right ventricular outflow track causing outflow obstruction, a murmur associated with right ventricular outflow tract obstruction (acquired pulmonic stenosis) and right ventricular hypertrophy. Vegetative endocarditis was not present. Medical management was unsuccessful, but surgical drainage and long‐term antimicrobial therapy were effective and the horse returned to a successful racing career.     

Caudal mediastinal abscess due to a grass awn (Hordeum spp) in a cat

A two-and-a-half year-old male, domestic shorthaired cat was presented with a history of chronic expiratory dyspnoea, dysphagia and progressive weight loss. Thoracic radiography revealed a caudal mediastinal mass. Surgical exploration confirmed the presence of an abscess in the caudal mediastinum. Despite the good prognosis, euthanasia was performed at the owner's request and post-mortem examination revealed an abscess that had been caused by a grass awn located within.     

Chylothorax in cats: is there a role for surgery?

Chylothorax is a complex disease with many identified underlying causes including cardiac disease, mediastinal masses, heartworm disease and trauma. Management of this disease should be directed at identifying the cause, if possible, and treating the underlying disorder. In cats with idiopathic chylothorax, medical management is recommended initially because the condition may resolve spontaneously. Owners should be made aware of the potential development of fibrosing pleuritis in affected cats. When medical management is impractical or unsuccessful, surgical intervention should be considered. Surgical options include mesenteric lymphangiography and thoracic duct ligation, pericardiectomy, omentalisation, passive pleuroperitoneal shunting, active pleuroperitoneal or pleurovenous shunting, and pleurodesis. Of these, only thoracic duct ligation and pericardiectomy are preferred by the author because, if successful, the result is complete resolution of the chylothorax, thereby reducing the risk of developing fibrosing pleuritis. Omentalisation may be beneficial in some animals as adjuvant therapy, but this procedure may still allow fibrosing pleuritis to occur. Until the aetiology of the effusion in cats with idiopathic chylothorax is understood, the treatment success rate will be less than ideal. Future research needs to be directed at determining the pathophysiologic mechanisms underlying this disease in cats.     

Use of intraoperative impression smear cytology to guide successful treatment of a large renal cyst in a dog: a case report

A 13-yr-old Shih tzu was referred for surgical management of right-sided cranial abdominal mass, which corresponded to large, cavitated renal mass on ultrasonography, and was suspected to represent neoplasia. Intraoperative impression smear cytology (ISC) of the renal mass wall was consistent with benign renal cyst (RC), without evidence of neoplasia or infection. Deroofing and omentalisation were performed and histopathology was consistent with benign RC. Chronic kidney disease was diagnosed 4 mon postoperatively, however, the dog was asymptomatic, without cyst reoccurrence. Intraoperative ISC is an expedient and inexpensive diagnostic technique that can guide most appropriate treatment in dogs with large RCs.     

Pancreatic pseudocyst causing extrahepatic biliary obstruction in a dog

A 3-year-old Rhodesian Ridgeback was examined because of recurrent pancreatitis of 2 months duration. The dog had signs of abdominal pain and jaundice. Blood biochemical findings were consistent with extrahepatic bile duct obstruction, but on abdominal ultrasonography no cause of obstruction was identified. At surgery a pancreatic pseudocyst was found in the body of the pancreas. Cystoduodenostomy, cystic omentalisation and biliary diversion resulted in excellent long-term recovery.     

Use of omental pedicle grafts in the management of non-healing axillary wounds in 10 cats

A retrospective analysis of the clinical case histories of 10 domestic shorthaired cats that underwent omentalisation, using a vascular pedicle of greater omentum, of chronic non-healing axillary wounds was carried out. Wounds were debrided and closed in a primary fashion following omentalisation. The cats had undergone a modal number of three previous repair attempts over a three- to 18-month period (mean 11 months) before referral. Further dehiscence occurred in eight cases, requiring a modal number of one further attempt at closure of the wound. Other complications included incisional herniation (two cats), serous exudate from the axillary wound (two cats) and paracostal abscessation (one cat). Long-term cure was achieved in seven of the 10 cases, with wounds finally having healed at a mean of 24 days post-omentalisation. Chronic axillary wounds are particularly difficult to treat and there are no reports of consistently successful techniques for their repair. This report suggests that omentalisation of these wounds may be a step towards such a repair procedure.     

The diagnosis and treatment of a thoracic abscess in an alpaca

A 6-month-old alpaca presented for lethargy, failure to thrive and leucocytosis. Diagnostic procedures, including thoracic ultrasound, radiographs and a computed tomography scan, were used to document a thoracic mass. Based on appearance and ultrasound-guided aspiration of purulent material, the mass was determined to be a large abscess. The abscess was treated with surgical drainage and long-term antibiotic therapy. The origin of this thoracic abscess was felt to be the caudal mediastinum, secondary to bacterial seeding of the caudal mediastinal lymph nodes. Although an aetiological agent was not definitively determined, the most likely was Actinomyces spp or Arcanobacterium pyogenes. The alpaca made a complete recovery following treatment.     

Post-traumatic paraureteral urinoma in a cat

A retroperitoneal urinoma (uriniferous pseudocyst) was diagnosed in a domestic shorthair cat exhibiting a sublumbar swelling two weeks after a road traffic accident. Plain radiography revealed a soft tissue opacity in the left retroperitoneal space. Intravenous urography and fine-needle aspiration were diagnostic. Contrast was seen pooling in the dilated ipsilateral renal pelvis and proximal ureter. Fluid aspirated from the retroperitoneal space had a creatinine level five times that of serum. Surgical drainage followed by nephrectomy and omentalisation of the pseudocyst was curative.     

Tracheal compression secondary to abscessation of cranial mediastinal lymph nodes in a horse

Respiratory distress and laryngeal paralysis were found to be caused by a Streptococcus equi abscess of cranial mediastinal lymph nodes, putting pressure on the trachea at the thoracic inlet. Surgical drainage was required to relieve the compression, and long-term antibiotic therapy was used to treat the bacterial infection. The trachea returned to normal diameter but left laryngeal hemiplegia persisted. Peritracheal abscesses should be considered in the differential diagnosis of inspiratory dyspnea of the horse.     

Intraabdominal torsion of a neoplastic testicle and prostatic cyst in a cryptorchid dog

The present report describes a case of a nine-year old male bilaterally cryptorchid boxer presented with testicular torsion and concurrent prostatic cyst. Clinical signs included anorexia, locomotor difficulty and apathy. Abdominal palpation revealed the presence of a hard and painful mass in caudal abdomen. Ultrasonographic findings were compatible with testicular torsion and prostatic cyst, confirmed at surgery. Bilateral orchiectomy and omentalisation were performed. Histopathological examination of the torsed testicle revealed alterations consistent with seminoma.     

Combination of medical and surgical therapy for pleuropneumonia in a horse.

Medical management was unable to prevent the development of an extrapulmonary abscess in a 10-year-old Thoroughbred gelding with anaerobic pleuropneumonia. Intercostal thoracostomy achieved drainage of the abscess. Resolution of the abscess and subsequent bronchopleural fistulas was monitored by ultrasonography and video-endoscopy. The horse returned to training 4 mo after discharge.     

Bacterial Pleuritis with Thickened Mesothelial Hyperplasia in a Young Beagle Dog

A five-month-old male beagle dog suddenly became moribund. Bloody fluid accumulated in the thoracic and abdominal cavities, and soft yellow flecks were floating in the thoracic fluid. The mediastinum and pericardium became dark reddish with villous thickening. Other parietal and pulmonary pleurae were rough, and the organs adhered to each other. Histologically, most mediastinal pleura formed papillary projections covered by a single layer of mesothelial cells. Many macrophages and neutrophils infiltrated the submesothelial connective tissue. At the mediastinum adjacent to the pericardium, cuboidal mesothelial cells proliferated solidly and formed a thick surface stratum. The flecks consisted of gram-negative filamentous or small bacillary (coccoid) bacteria. In the right posterior lobe of the lung, neutrophilic infiltration and a large encapsulated abscess including a bacterial colony were present. We diagnosed this case as “bacterial pleuritis with thickened mesothelial hyperplasia”. The cause of the pleuritis might be a chronic pleural infection spread via the lung abscess.     

Use of Intraoperative Ultrasonography to Identify a Cervical Foreign Body A Case Report

Real-time ultrasound was used to identify a foreign-body abscess causing an extraluminal esophageal obstruction in the neck of a horse. Surgical exploration to remove the foreign body and drain the abscess was performed after 2 months of medical management that had failed to resolve the problem. The abscess could not be visualized because there was no draining tract or other localizing sign of inflammation. Ultrasound was used aseptically to guide surgical dissection to the walled off abscess with minimal damage to adjacent vital structures in the surgical field. The signs of esophageal obstruction abated and have not recurred in 15 months.     

Lateral orbitotomy for treatment of an orbital abscess in a dog

A two‐year‐old Jack Russell terrier was diagnosed with a retrobulbar abscess and orbital cellulitis. The diagnosis was confirmed by ultrasound, magnetic resonance imaging examination and ultrasound‐guided fine‐needle aspiration. Transoral ventral drainage was attempted but was unsuccessful. The abscess was successfully treated by open drainage through a lateral orbitotomy. Despite the exposure of the orbital structures, the orbital soft tissues healed by second intention without further complications. The open drainage was well tolerated and resulted in immediate reduction of inflammation and pain, allowing a quick recovery. This report describes the diagnosis and, surgical management and the long‐term (3 years) follow‐up of an unusual case of orbital abscess associated with diffuse periorbital cellulitis successfully treated by open drainage through a lateral orbitotomy.     

Nonsurgical resolution of caudal mediastinal paraesophageal abscess in a cat

A one-year-old, castrated male domestic short hair cat was admitted with a history of anorexia, regurgitation and pyrexia for two days. Fever and leukocytosis were identified. There were a large soft tissue density oval mass in the caudal mediastinum on thoracic radiographs, a fluid-filled oval mass in the caudal mediastinum on ultrasonography, and left-sided and ventrally displaced and compressed esophagus on esophagram. On esophageal endoscopy, there were no esophageal abnormalities. CT findings with a fluid filled mass with rim enhancement indicated a caudal mediastinal paraesophageal abscess. The patient was treated with oral antibiotics, because the owner declined percutaneous drainage and surgery. The patient was admitted on emergency with severe respiratory distress; and ruptured abscess and deteriorated pleuropneumonia were suspected. With intensive hospitalization care and additional antibiotic therapy, the patient had full recovery.     

In this issue – June 2011

Computer model predictions and field observations of anthelmintic resistance in sheep · Dangers of off‐label use of barium selenate · Elbow luxation in dogs and cats · Prognosis of joint infections in adult horses · Omentalisation for mediastinal abscess in a dog · Adenoviruses in lizards     

Surgical management of a canine intracranial abscess due to a bite wound

Objective – To describe the successful surgical management of a brain abscess in a dog secondary to bite wound. Case Summary – A 10‐year‐old neutered female Welsh Corgi/Chihuahua, weighing 5.3 kg, was presented for evaluation of seizures, ataxia, and falling to the left 8 days after a presumptive fight with another dog. On examination at presentation, the dog was alert, responsive, and ambulatory with tetra‐ataxia, falling to the left, left‐sided postural deficits, and absent left menace response. Within 24 hours, the dog progressed to nonambulatory tetraparesis with minimal motor, absent postural reactions of all limbs, left nasal hypalgesia, reduced gag reflex, and depressed mentation. Computed tomographic images of the brain were suggestive of a bite wound fracture of the right parietal bone with secondary meningoencephalitis, right parietal lobe abscessation, and white matter edema adjacent to the bone fracture. A modified right rostrotentorial craniectomy was performed, the abscess was identified, contents of the abscess were removed, and the surgical site was flushed extensively before closing. Corynebacterium spp. was cultured from within the abscess. Within hours of surgery, the dog was quiet but alert, responsive, and sitting up in her cage. In addition to surgical intervention, intensive care, broad‐spectrum IV antimicrobials, and supportive therapy led to significant neurologic improvement with only occasional seizures and mild postural reaction deficits of the left hindlimb remaining. New or Unique Information Provided – Abscess formation within the CNS is uncommon in dogs and cats and is associated with a high mortality rate. In veterinary medicine the management of brain abscesses is controversial with limited information available regarding treatment. This is the first case report that demonstrates surgical intervention in combination with antimicrobial therapy can be used successfully in the treatment of a canine brain abscess.     

Corneal stromal abscess in a cat

A corneal stromal abscess was diagnosed in a 13-year-old domestic shorthaired cat. A superficial keratectomy was performed to obtain samples for cytological and bacteriological examination. These confirmed the diagnosis and, following medical management with topical and systemic antibiotics, the lesion resolved completely.     

Post-trauma inguinal seroma formation in the cat

Seven cats presented with large caudoventral abdominal or inguinal swellings following road traffic accidents. No case had evidence of disruption to the body wall or inguinal ring and the inguinal swellings may have been the result of either shear or compressive injury to soft tissues of the inguinum or disruption of the regional lymphatics. Six cases resolved completely following strict rest or simple Penrose drain placement with no recurrence reported. Recurrence of seroma was seen in one case but which then fully resolved following omentalisation of the inguinum.